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Health care utilization and end-of-life care for older patients with acute myeloid leukemia.

Publication ,  Journal Article
El-Jawahri, AR; Abel, GA; Steensma, DP; LeBlanc, TW; Fathi, AT; Graubert, TA; DeAngelo, DJ; Wadleigh, M; Ballen, KK; Foster, JE; Attar, EC ...
Published in: Cancer
August 15, 2015

BACKGROUND: Health care utilization in older adults (age ≥60 years) with acute myeloid leukemia (AML) has not been well studied. METHODS: We conducted a retrospective analysis of 330 consecutive older patients who were diagnosed with AML between May 1, 2005 and December 23, 2011, at 2 hospitals in Boston to examine their health care utilization and end-of-life care. Using multivariable logistic and linear regression models adjusting for covariates, we also compared health care utilization between patients who received intensive induction chemotherapy (n = 197; cytarabine/ anthracycline combination) versus nonintensive chemotherapy (n = 133; single-agent therapy). RESULTS: The median number of hospitalizations for the entire cohort was 4.2 (range, 1-18 hospitalizations). Patients who died spent a mean of 28.3% of their life after diagnosis in the hospital and 13.8% of their life attending outpatient clinic appointments. Although the majority of patients (87.9%) died during the 2-year follow-up period, a minority received palliative care (16.2%) or hospice (23.1%) services. Within 30 days of death, 84.5% of patients were hospitalized, and 61% died in the hospital. Among the patients who died, those who received intensive induction therapy (vs nonintensive therapy) spent 30% more of their life after diagnosis in the hospital (P < .0001) and were less likely to receive hospice services (odds ratio, 0.45; P = .05). CONCLUSIONS: The current findings highlight the intensity of health care utilization among older patients with AML, regardless of treatment modality. Despite the poor prognosis, palliative care and hospice services are rarely used. Future work should study novel health care delivery models to optimize care throughout the course of illness and at the end of life.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

August 15, 2015

Volume

121

Issue

16

Start / End Page

2840 / 2848

Location

United States

Related Subject Headings

  • Terminal Care
  • Retrospective Studies
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Logistic Models
  • Leukemia, Myeloid, Acute
  • Humans
  • Female
 

Citation

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Chicago
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El-Jawahri, A. R., Abel, G. A., Steensma, D. P., LeBlanc, T. W., Fathi, A. T., Graubert, T. A., … Temel, J. S. (2015). Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer, 121(16), 2840–2848. https://doi.org/10.1002/cncr.29430
El-Jawahri, Areej R., Gregory A. Abel, David P. Steensma, Thomas W. LeBlanc, Amir T. Fathi, Timothy A. Graubert, Daniel J. DeAngelo, et al. “Health care utilization and end-of-life care for older patients with acute myeloid leukemia.Cancer 121, no. 16 (August 15, 2015): 2840–48. https://doi.org/10.1002/cncr.29430.
El-Jawahri AR, Abel GA, Steensma DP, LeBlanc TW, Fathi AT, Graubert TA, et al. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015 Aug 15;121(16):2840–8.
El-Jawahri, Areej R., et al. “Health care utilization and end-of-life care for older patients with acute myeloid leukemia.Cancer, vol. 121, no. 16, Aug. 2015, pp. 2840–48. Pubmed, doi:10.1002/cncr.29430.
El-Jawahri AR, Abel GA, Steensma DP, LeBlanc TW, Fathi AT, Graubert TA, DeAngelo DJ, Wadleigh M, Ballen KK, Foster JE, Attar EC, Amrein PC, Brunner AM, Stone RM, Temel JS. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015 Aug 15;121(16):2840–2848.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

August 15, 2015

Volume

121

Issue

16

Start / End Page

2840 / 2848

Location

United States

Related Subject Headings

  • Terminal Care
  • Retrospective Studies
  • Patient Acceptance of Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Logistic Models
  • Leukemia, Myeloid, Acute
  • Humans
  • Female